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AS Medicaid works to prevent “people from going into crisis"

Sat, 09/30/2017 - 11:17am

Medicaid office hopes reimbursement program will encourage more visits

By

Blue Chen-Fruean

blue@samoanews.com

Members of the local community are pleased with the announcement earlier this month that the American Samoa Medicaid Agency is now reimbursing facility fees for all legal residents to the Department of Health's Federally Qualified Health Center (FQHC) and its five Community Health Centers (CHC) in Leone, Tafuna, Amouli, Ofu, and Ta'u.

This means qualified legal residents no longer have to pay $10 for visits to the DOH health centers.

In response to Samoa News questions about the program, Director of the American Samoa Medicaid Office, Tofoitaufa Sandra King Young said, "It is the policy of the Medicaid program to help Medicaid eligible beneficiaries access primary care services for health promotion and disease prevention."

She continued, "We want to encourage people to seek early detection and engage in prevention and health care management."

Under the program, all legal residents can now seek dental services, mental health services, and primary care services - even cancer screening for women - at all DOH community health center for free. This does not apply to prescriptions.

"This will be a permanent benefit so long as there is local match and federal match dollars for the Medicaid program," Tofoitaufa explained.

When asked about the benefits of the program, Tofoitaufa responded that, "By doing away with the facility fees, the hope is that more people will seek care before they get too sick. It is better to prevent the onset of disease rather than to treat, especially in the late stages. We want to prevent people from going into crisis."

Tofoitaufa pointed out that any qualified practitioner could carry out the services, as outlined in the Medicaid State Plan.

On Sept. 15th, the ASMO director shared that the Medicaid office, under the Lolo Administration, worked closely with the Centers for Medicare & Medicaid Services (CMS) to develop a payment method for the FQHC community health centers.

And even though the FQHC could have been a Medicaid provider when it was designated an FQHC, Tofoitaufa said the American Samoa State Plan did not have a payment method or eligible provider provision for the FQHC.

"This required significant justification, financial modeling and analysis by the Medicaid agency to justify the payment method for the FQHC before Medicaid could officially submit a request to CMS, to make the DOH FQHC community health centers eligible for Medicaid funding reimbursement," Tofoitaufa wrote.

For now, local residents are thankful, especially those who are in the low income bracket and opt to self-medicate at home when they are sick, instead of forking out $10 to seek medical assistance at the health centers.

With the reduction in government work hours, the looming 5-week StarKist shutdown, and the Fono proposal of a 7% sales tax, "anything that can save us money is a blessing," said one local mother of six who says she spends hundreds a year on medical care, especially for her youngest kids.

"Even though prescriptions are not covered under this program, just being able to see the doctor for free is such a wonderful benefit," she said.